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Systemic Anti-Cancer Therapy Regimen Library

Home > BR Adjuvant - AC [DOXOrubicin and CYCLOPHOSPHamide] dose dense followed by PACLItaxel dose dense

BR Adjuvant - AC [DOXOrubicin and CYCLOPHOSPHamide] dose dense followed by PACLItaxel dose dense

Treatment Overview

This regimen consists of two parts: AC [DOXOrubicin and and CYCLOPHOSPHamide] dose dense followed by PACLitaxel dose dense.


This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycles 1 to 4 - 14 days - AC [DOXOrubicin and and CYCLOPHOSPHamide] dose dense

Cycle length:
14

Cycles 5 to 8 - 14 days - PACLItaxel dose dense

Cycle length:
14

Cycle details

Cycles 1 to 4 - 14 days - AC [DOXOrubicin and and CYCLOPHOSPHamide] dose dense

Medication Dose Route Days Max Duration
olanzapine * 2.5 mg oral administration 1 to 4
aprepitant 125 mg oral administration 1
aprepitant 80 mg oral administration 2, 3
dexamethasone * 12 mg oral administration 1
ondansetron 8 mg oral administration 1
DOXOrubicin 60 mg/m² intravenous 1 15 minutes
CYCLOPHOSPHamide 600 mg/m² intravenous 1 60 minutes
ondansetron 8 mg oral administration 1
pegFILGRASTIM 6 mg subcutaneous injection 2
cyclIZINE 50 mg Three times daily oral administration 1

Cycles 5 to 8 - 14 days - PACLItaxel dose dense

Medication Dose Route Days Max Duration
dexamethasone * 20 mg oral administration 0, 1
loratadine * 10 mg oral administration 1
PACLItaxel * 175 mg/m² intravenous 1 3 hours
pegFILGRASTIM 6 mg subcutaneous injection 2
domperidone 10 mg Three times daily oral administration 1

Full details

Cycles 1 to 4 - 14 days - AC [DOXOrubicin and and CYCLOPHOSPHamide] dose dense

Day: 1

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONE hour prior to chemotherapy. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
  • Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment.
aprepitant 125 mg oral administration
Instructions:

ONE hour prior to chemotherapy.
dexamethasone * 12 mg oral administration
Instructions:

ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
DOXOrubicin 60 mg/m² intravenous 15 minutes
Instructions:

Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.

CYCLOPHOSPHamide 600 mg/m² intravenous 60 minutes
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.
cyclIZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
  • Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation.

Day: 2

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:

ONCE daily in the morning.
pegFILGRASTIM 6 mg subcutaneous injection

Day: 3

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:

ONCE daily in the morning.

Day: 4

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Cycles 5 to 8 - 14 days - PACLItaxel dose dense

Day: 0

Medication Dose Route Max duration Details
dexamethasone * 20 mg oral administration
Instructions:

Take the night prior to paclitaxel infusion with food.

  • If the initial infusion(s) of paclitaxel are well tolerated, clinicians may decide at their discretion, to omit this dose.

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 20 mg oral administration
Instructions:

ONE hour (or timing as per institutional policy) prior to paclitaxel infusion with food. 
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion.

PACLItaxel * 175 mg/m² intravenous 3 hours
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Day: 2

Medication Dose Route Max duration Details
pegFILGRASTIM 6 mg subcutaneous injection

Supportive Care Factors

Factor Value
Emetogenicity: Variable
Growth factor support: Recommended for primary prophylaxis
Hypersensitivity / Infusion related reaction risk: Variable

Emetogenicity:

  • HIGH cycles 1 to 4.
  • LOW cycles 5 to 8.

Hypersensitivity / Infusion related reaction risk:

  • HIGH - routine premedication recommended cycles 5 to 8.

References

Citron, M. L., D. A. Berry, C. Cirrincione, et al. 2003. "Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment. J.Clin Oncol. 21(8):1431-1439., PMID: 12668651

Gray, R., R. Bradley, J. Braybrooke, et al. 2019. "Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials." The Lancet 393(10179):1440-1452., PMID: 30739743

Novartis New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 16 April 2020. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 26 November 2020)

Boulanger J, Boursiquot JN, Cournoyer G, et al. Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. Curr Oncol. 2014;21(4):e630-e641., PMID: 25089112

Tabernero J, Vyas M, Giuliani R, et al. Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers. ESMO Open. 2017 Jan 16;1(6):e000142. doi: 10.1136/esmoopen-2016-000142., PMID: 28848668

Lyman GH, Balaban E, Diaz M, et al. American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol. 2018 Apr 20;36(12):1260-1265. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14., PMID: 29443651

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.